ngo code of conduct for health systems strengthening julia robinson, mph msw april 8, 2014
TRANSCRIPT
NGO Code of Conduct for Health Systems Strengthening
Julia Robinson, MPH MSWApril 8, 2014
HEALTH ALLIANCE INTERNATIONAL
Outline
Why a code of conduct? NGO Code of Conduct contents Research into implementation of the
Code Discussion
How best to use this Code? Are voluntary codes of conduct good tools
for changing practices?
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Why a code of conduct?
Development aid for health quintupled since 1990, to $27.7 bn in 2011
US flows more than 50%of aid through NGOs
Source: IHME/Murray et al, 2011
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Why a code of conduct?
Weak public sector health
system
Fragment-ation
Mgmt burden
Brain drainInefficien-cies
Loss of services
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Why a code of conduct?
There are many factors contributing to weak public sector health systems – why focus on NGOs?
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Why a code of conduct?
Lots of them already exist …NGOs
Responding to HIV/AIDS, Disaster Relief, International Philanthropy, general codes of ethics and conduct, etc. One World Trust CSO Project:
http://www.oneworldtrust.org/csoproject/
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Why a code of conduct?
Specifically, codes have been used for health workforce and recruitment efforts WONCA’s “Melbourne Manifesto”
(2002) Commonwealth Code of Practice
(2003) UK’s Code of Practice (2004) Voluntary Code of Ethical
Conduct for the Recruitment of Foreign-Educated Nurses to the U.S. (2008)
WHO Code of Practice on the international recruitment of health personnel (2010)
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NGO Code of Conduct for HSS
Coalition of organizations worked on drafting and consultations starting in 2007
Launched in May 2008
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NGO Code of Conduct for HSS
6 articles: Hiring practices Employee compensation
practices Human resources training
and support to systems Impact of management
burden on ministries of health
Support of MOH engagement with communities
Policy advocacy for strengthening public sector
ngocodeofconduct.org
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NGO Code of Conduct for HSS
6 articles: Hiring practices Employee compensation
practices Human resources training
and support to systems Impact of management
burden on ministries of health
Support of MOH engagement with communities
Policy advocacy for strengthening public sector
ngocodeofconduct.org
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First 3 articles: Human resources
• Avoid hiring away from MOH• Coordinate with MOH in hiring• Hire nationals where possible (rather than
expats)• Avoid creating incentives for migration
Hiring• Fair monetary compensation, limit
disparities• Strive for salaries not substantially greater
than public sector• Avoid top-ups to MOH staff for outside work• Try to improve public sector benefits/pay
Compensation
• Invest in pre-service education to increase number of workers
• Build capacity of public sector workers (including mgmt)
Training and Support
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Implementation so far
57 signatories today in 14 countries Thesis research by Anjali Sakhuja (MPH
2009) Questions:
How are signatories implementing the Code of Conduct?
What are best practices? What are challenges to operationalizing the Code?
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Findings: Hiring
Most respondents make efforts to avoid hiring from the MOH
Have hired in the case of Person already resigned from MOH With permission from MOH In “after-hours” setting (also with
permission) Challenges:
Rural posts Project deadlines/pressure Ethics of refusing to hire due to MOH
employment
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Findings: Hiring
Expatriates are hired when special expertise is needed; try to make it the exception rather than the rule
Challenges Can’t hire from MOH (nationals), can’t hire
expats – what if there isn’t anyone else? Bureaucracy to hire expats Expats from non-Western countries fleeing
conditions in home countries
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Findings: Compensation
NGO salaries can be 10x greater, or more
Challenges Low salaries make hiring and
retention difficult Market pressures Finding an elusive balance
Working conditions can be as important as salary considerations
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Suggestions and promising practices
Visibility of Code Post in lobby, include in
orientation Improve public sector
opportunities Highlight value in setting
policy, broader impact Invest in career path
opportunities Second staff to the MOH
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Suggestions and promising practices
Advocacy
Donors should support/fund in line with Code
Make signing on to the Code a condition of receiving funds
Why not get the big players on board?
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Summary
Awareness, but few changes to HR policies
Commitment to principles, challenges with hiring and compensation items
Testing ideas in the field Importance of more pre-
service training Some efforts to
coordinate amongst NGOs
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Discussion
How best to use the Code? Is a voluntary Code a good tool for
changing practices? Other questions or thoughts?
Thank you!